As controversies mount, circumcision policies need a rethink

The recent criminal sentencing of a UK-based former paediatric surgeon for performing unauthorised childhood circumcisions for cultural and religious purposes-despite having been previously struck off the General Medical Council medical register for performing unsafe circumcisions-has renewed debate and concern over how societies should regulate this practice. Current clinical guidance on non-therapeutic childhood penile circumcision engages a complicated intersection between medicine, religion and secular culture, giving rise to conflicting arguments over how medical advice should be approached. Some argue there is a greater need for medical oversight in licensing, while others attest that the procedure itself is unethical and thus should be discouraged outright. Still others suggest that clearer guidance is needed regardless of one's position, as the lines between medical and non-medical advice have been muddled. As the complex interplay of medicine, religion and culture in relation to circumcision is most pronounced in the USA, where the practice of non-therapeutic newborn circumcision is common, this article examines the subject through a novel assessment of the most recent and highly influential American Academy of Paediatrics (AAP) policy statement on the practice, with an eye to seeing what might be learnt by health and regulatory authorities as they grapple with this issue. Commentary given for the article by contributors to the AAP policy, as well as consideration of the mixed reception of the policy by the medical community and members of the public, suggests that (at minimum) guiding authorities in the USA, UK and elsewhere must more clearly articulate the line between medical and non-medical practice.